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14 week old baby, dropping weight percentiles?

Hello there

This is my first post, so please bear with me!

My baby (second child, exclusively breastfed) was weighed on Wednesday at 14 weeks old, and the Health Visitor expressed concern that he had dropped down two percentile lines on his chart. He started out a big boy (much bigger than I expected) at 8lbs 15oz, which looks to be around the 91st percentile line. He regained his birth weight quickly, and remained between the 75th and 91st lines. At 8 weeks, he dropped to between the 50th and 75th, at 12 weeks he was at the 50th (13lbs 3oz), and on Wednesday he was around the 30th percentile (13lbs 7oz).

He has gained weight every time, but only 4oz in the last two weeks.

I took him to the GP upon the health visitor's advice, and the GP said she wasn't concerned and the overall picture looks good-- he's happy and alert, and he looks healthy. I've been advised to have him weighed again in two weeks.

Some info that might be relevant--
- He has loads of wet nappies/day. Bowel movements vary, but he's having around 3/day at the moment. Usually yellow, occasionally green if he's been gassy.
-We both have had a cold for a couple of weeks
-He was born with a tongue tie, which we had released at 2.5 weeks. It took a little while to adjust afterwards, but we were also battling overactive letdown, thrush for weeks later on, and he has a lip tie too. I have no pain now, the thrush is gone, and he seems happy. I don't think he latch is absolutely perfect, but I think he drains my breasts.
-He's a bit refluxy, although rarely seems bothered by it and I know this is common. My daughter had quite significant reflux and didn't drop percentiles, although she fed very frequently day and night.
-When I look back, my daughter was pretty much exactly the same weight at his age; however, she's a girl so it plots a bit higher, and she hadn't dropped so much because she started out at 7lbs 9.5oz.
-He has always slept well, and has been sleeping a good 10-hour stretch at night since 8 weeks. My daughter was the opposite - woke very frequently until I weaned her at 21 months.
-He sucks his thumb, and has done since 10 weeks
-I think he feeds around 7-8 times per day, nothing at night. Comes off smiling and looking satisfied. He's such a placid little thing.

Re: 14 week old baby, dropping weight percentiles?

Welcome to the forum!

I think the pediatrician's lack of concern trumps the concern from the HV. Everything your baby is doing sounds entirely normal- he's producing plenty of diapers and the poops are yellow. At is nursing frequency is a little low but still in the normal range. Nursing is pain-free.

What may be happening is something called catch up/catch down growth, where a baby follows one growth trajectory inside the womb but a different one outside the womb. This means that babies can be born small or average and shoot up to the top of the charts, or be born big or average and then decline to a lower curve. What is important is that the baby continue to grow and develop normally as he wiggles around on the charts. Declining on the charts is not in and of itself a concern- just an indicator to watch the baby a little more carefully.

One thing that you might want to think about changing is that long, long sleep stretch at night. Some very placid babies and/or babies who are content to get their sucking needs met with a thumb or pacifier will not eat enough to grow at their optimum rate. I would think about adding in 1-2 "dream feeds" at night- just wake the baby right before you go to bed and nurse him, and then nurse him again if you get up to pee or something. That increase in intake might be enough to give him a boost on the chart.

You also might want to consider taking away any sleep-extending techniques like swaddling, using a swing, or a pacifier (though it sounds like your son is a thumb guy and there's no way to take his thumb away!). Some babies sleep less "well" and eat more when those things are taken away.

Re: 14 week old baby, dropping weight percentiles?

Hi

Thank you for your response! I thought doing about a dream feed. I go to bed early and not long after him, so it would involve me setting an alarm, but I will happily do that if he needs it. I was waking him to feed in the first couple of weeks because he was jaundiced, but haven't at night since. He doesn't have any of those sleep aids. He's in a cosleeper next to me, never swaddled. I'm still amazed at the sleep-- my daughter was such a different story!

Just to be clear, I haven't seen a paediatrician (not the normal protocol here). Just the HV and a GP. GPs don't tend to have much breastfeeding training, although this one did reference her own daughter's drop from the 50th to 25th as being normal.

Re: 14 week old baby, dropping weight percentiles?

Here in the US where mommal and I are, most doctors, even pediatricians, have very little breastfeeding training.

But they sure know growth charts, (even if at times they do not really understand what they mean) and often way over- rely on them for assessing health. They also have the training to recognize other signs of ill health or too little nutrition.

I don't know what training hv's have. But your hv sent you to the doctor for a second opinion. So i would agree with mommal-doctor is happy, that is a good sign.

I also agree it never, ever hurts to nurse more often. Nursing even once or twice more each day (even if at night) equals 2-6 more ounces into baby each day and of course is beneficial yo milk production as well. 10 hours is a very long sleep stretch at this age and could potentially reduce milk production.

Were those last two checks that showed a 4 ounce gain in two weeks on the same scale?

Re: 14 week old baby, dropping weight percentiles?

Sounds like you found a good GP, then! As LLLMeg said, a lot of pediatricians have no breastfeeding training and are only happy with breastfed babies if they are "unicorn" babies- not too big, not too small, nursing at 3 hour intervals, sleeping through the night... Can't tell you how much trouble that lack of education causes!

Based on what mamas have posted here WRT health visitors, my perception is that there are a significant number of them who expect all babies to be unicorn babies. If a baby varies from its growth curve, or doesn't sleep through the night, or nurses "too often", then they suggest interventions like formula or solids. Don't get me wrong, I think the concept of HVs is an excellent one- but I suspect that the breastfeeding training HVs get is just not what it should be. And of course your HV didn't do anything dumb like suggest stretching out your baby's feedings or supplementing unnecessarily- she just sent you in to see the doc, which is, IMO, an appropriate response to a concern.

Let us know how things go! I'm really curious to find out if a dream feed makes a difference for your baby.

Re: 14 week old baby, dropping weight percentiles?

I think the health visitors can reallllly vary. The one I'm assigned to hasn't been very good with breastfeeding, but luckily she's not the one I've encountered at the regular weighing clinics. The HV I saw on Wednesday did say that she was referring me to the GP because it's their protocol if babies drop below two percentile lines, but that I shouldn't worry too much and it wasn't a problem with my milk (i.e. she was indirectly saying she wasn't going to throw formula at me ). She also agreed that trying to add another feed in would be good, although she didn't think doing it at night would work because he'd be too sleepy...

After I posted, we had a really nice cluster session for 90 minutes, which we haven't done for weeks. Maybe it was coincidental, maybe he's due a growth spurt, or maybe I just gave him more time. Then later, I gave him a dream feed at 10pm. He only took one side where normally he takes two, but it was a really good one side (half an hour, really drained). This afternoon, we had another cluster session, and I've been really conscious of offering lots.

Whilst I haven't enjoyed the worry, I think this has been a good thing for me in evaluating how we spend our time during the day. I'm always rushing around trying to entertain my (very busy, very demanding) preschooler, keeping the house immaculate, cooking, etc, whilst my husband works a LOT, and I think I haven't spent enough time just ...being...with my baby.

One more thing though. I've been thinking more about how sicky he can be, and I'm wondering if he's reacting to something I'm eating. His poos are more than "occasionally" green/mucousy, now I think about it (he's had 3 today and 1 was green, seedy and watery around the edges, the next was less watery but mucousy and greeny, and the last was yellower but still a bit mucousy), and our initial oversupply issues are gone. Although, he has had a cold and is a bit dribbly. I don't want to cut anything out until I've tracked things a bit more, but wondering if I should look into this more? I'm trying to make sure he really drains each breast as a start.

Thank you so much for all your support. Also, I've contacted a local breastfeeding counsellor who supported me online in the early tongue tie days, and I'm going to meet with her on Wednesday. Looking forward to that.

Re: 14 week old baby, dropping weight percentiles?

Have you been told to make sure baby "drains" each breast every time as a way to combat oversupply/forceful letdown? Slow gain? Or just as a general idea? Or was this suggested due to milk transfer issues, due baby's tongue tie?

The Womanly Art of Breastfeeding nor most resources I am aware of do not make this recommendation, which is potentially problematic for a few reasons (What is meant by "drained" exactly, when the breast is always making milk, for example.) Instead, encouraging frequent nursing, day and night, with baby being allowed to nurse on one or both sides each time as baby prefers is generally what is suggested if baby is gaining normally and/or there is overproduction.

If there is a slow weight gain issue, especially if it is related to LOW milk production, then actively encouraging baby to switch sides once or more each feeding is a method to increase production/get more milk into baby.

Also, babies nurse quite well even WHILE asleep (or drifting into sleep) so I am not sure what the concern is with baby being 'too sleepy' to nurse, (unless you are scheduling feeds which it does not sounds like it is the case.)

Re: 14 week old baby, dropping weight percentiles?

NAK

I mean because greeny/mucousy poo can be a sign of too much foremilk? I have just been trying to make sureI don't switch him to the other side until the first side seems slower. He pulls off during most feeds, sometimes several times, so it's not always clear when he's ready to switch sides.

Re: 14 week old baby, dropping weight percentiles?

It's not that it's a bad idea, if it’s not causing other issues. It’s just not necessary.

But it is suspected that your baby is possibly not gaining well, and slow weight gain has been connected to keeping baby on one side "too long." I would suggest nurse more often and let baby switch sides every time baby pulls off.

If you think baby is pulling off due to a fast flow, try nursing “laid back” with baby more on top of you. The frequent feedings should help with that as well.

Green poops and pulling off can indicate forceful letdown and overproduction, (but of course that is not consistent with slow weight gain.) Switch nursing directed by mom is not suggested in overproduction cases. But your baby is wanting to switch, so I would suggest, let baby. Green poops never hurt anyone-that can just be normal.